FAQ

Allergens in the environment include mould, plants (pollens), animals (saliva, pet hair and dander), cockroaches and dust mite.

Smoke and other irritants such as exhaust and strong chemical smells can also trigger allergic reactions.

Some people can be desensitised to some allergens including a variety of pollens and dust mite. This is also known as immunotherapy. Discuss desensitisation with your general practitioner who may then refer you to an allergy specialist.

If you have allergic rhinitis due to rye grass allergy, you are at risk of thunderstorm asthma, whether you have experienced asthma before or not.

Allergic rhinitis is considered severe if your  symptoms lead to you having one or more of the following:

• Disturbed sleep leading to daytime drowsiness
• Frequent waking due to breathing symptoms
• Restricted daily activities, sport or leisure
• Abnormal work and school performance

If symptoms are ongoing or difficult to control, even when taking medication, your doctor may refer you to an allergy specialist for management. You can also request a referral. Your specialist will review your symptoms and treatment and may discuss long term treatment known as allergen immunotherapy.

Symptoms may be regarded as mild when there is no disturbance in sleep, leisure, school or work activities.

When symptoms are long-term, allergic rhinitis may be associated with complications such as snoring, chronic tiredness, ear and sinus infections.

Check with the pharmacy. If they have adrenaline injectors with an expiry date of less than ten months, you can consider asking them to order you an adrenaline injector with a longer expiry date.

You may have to wait a couple of days for the order to arrive at the pharmacy, so do not leave it until the last minute to renew your adrenaline injector prescription.

You may also like to phone a few pharmacies in your area to see which pharmacy has adrenaline injectors with the longest expiry dates.

On rare occasions adrenaline injectors may not be available with expiry dates of more than ten months. If this occurs, it is better to accept an in-date adrenaline injector even if the expiry date is short.

If you purchase a device that has an expiry date less than 12 months, you can replace the devices through the PBS on authority prescription when they are due to expire.

You must replace your adrenaline injector if:

• you have used it
• it has been fired/triggered by accident
• it is about to expire or
• the liquid within the device becomes cloudy/discoloured or has floating particles.

NOTE: If you have used an adrenaline injector you should replace it immediately. You should always have at least one in-date adrenaline injector with you at all times.

Yes, they can be bought over the counter from any pharmacy.

An adrenaline injector purchased over the counter without a prescription will cost around $80 to $120.

Some private health insurance funds will cover part of the cost of adrenaline injectors purchased on a general prescription (not a PBS authority prescription).

Check with your private health fund whether you can get a rebate with your level of private health cover and if you need a a general prescription or if they offer rebates for adrenaline injectors purchased over the counter.

You will need to get a signed receipt from your pharmacist. You will need this receipt to make a private health insurance claim if you are entitled to it.

Adrenaline injectors can be purchased over the counter from any pharmacy. The cost will be around $80 to $120.

There is no government subsidy unless adrenaline injectors are prescribed to a specific individual on authority prescription.

Organisations that purchase an adrenaline injector for general use should keep an ASCIA First Aid Plan for Anaphylaxis (orange in colour) with the device.

ASCIA Action Plans can be printed from the Australasian Society of Clinical Immunology and Allergy (ASCIA) website – click here to download.

ASCIA has information on adrenaline injectors for general use.

You will be able to purchase the two adrenaline injectors on a PBS authority prescription for the Health Care Card prescription price.

There is no discount on over-the-counter devices bought without a PBS authority prescription.

Your adrenaline injector expires at the end of the month indicated on the device.

You should allow enough time to make an appointment to see your doctor/nurse practitioner for a PBS authority prescription and to take the prescription to your pharmacy.

Remember that the pharmacy may not have the adrenaline injector in stock and may need to order it in which may take a couple of days.

It is best to start the process of getting a prescription in the middle of the month the adrenaline injector expires in case there are any delays.

For information on ordering Anapen® stock, the pharmacy should contact the distributor (Arrotex) on 1800 195 055.

For information on ordering EpiPen® stock, the pharmacy should contact the distributor (Viatris) on 1800 931 625.

If they are unsuccessful, please ask the pharmacy to call Allergy & Anaphylaxis Australia on 1300 728 000.

Your doctor/nurse practitioner will prescribe the correct dose adrenaline injector based on the person’s weight.

Dose recommendations are also written on the ASCIA Action Plan for Anaphylaxis so they are easy to find in an emergency.

The type of adrenaline injector prescribed is based on a medical decision by the doctor as well as the patient/carer preference. Considerations may include the weight of the patient, history of anaphylaxis and the training on a new device.  

It is very important that you know how to use the type of device prescribed, especially if it is different to one you have used in the past.

Brands and doses of adrenaline injectors

There are two different brands of adrenaline injector available in Australia – Anapen® and EpiPen®.

The dose of the adrenaline injector is worked out by weight. Weight guidelines for adrenaline injectors can also be found on the bottom left-hand corner of ASCIA Action Plans.

Pharmacists can substitute one adrenaline injector for another if the “brand substitution is not permitted” box is not ticked or your prescription is for an Anapen junior or Anapen 300 (these devices are no longer available in Australia).

The pharmacist should:

• ask for your permission to do this
• show you how to use the adrenaline injector – instructions for using Anapen® and EpiPen® are different

It is important that you have an ASCIA Action Plan for Anaphylaxis that matches your adrenaline injector. 

If you do not have an Action Plan for Anaphylaxis that matches your adrenaline injector then you will need to go back to your doctor and get the matching Action Plan. 

You need to take your authority prescription to a pharmacy, and you will be given two adrenaline injectors.

The total cost for the two adrenaline injectors will be the cost of a single prescription.

The first PBS authority prescription needs to be provided by or in consultation with an allergy specialist, respiratory physician or a paediatrician. 

An initial PBS prescription may also be prescribed after you have been discharged from hospital or an emergency department after treatment with adrenaline for anaphylaxis.

A doctor (including a GP) or nurse practitioner can write follow-up prescriptions. The doctor/nurse practitioner will need to get an authority from Services Australia every time. You can only purchase two in-date adrenaline injectors through the PBS on authority prescription at any one time.

If you use one or both of your devices you can replace them with another two devices using an authority prescription, even if it has only been a short time since your last adrenaline injector authority prescription.

Your doctor/nurse practitioner should provide an ASCIA Action Plan for Anaphylaxis (red in colour) with every prescription for an adrenaline injector, even if your trigger allergens have not changed.

ASCIA Action Plans can be printed from the Australasian Society of Clinical Immunology and Allergy (ASCIA) website – click here to download.

The ASCIA Action Plan for Anaphylaxis is regularly updated with best practice emergency treatment advice for anaphylaxis.

NOTE: Adrenaline injectors are not usually prescribed for people with medication allergies even if they have had a previous anaphylaxis. This is because medications are much easier to avoid than food or insects for example.

Whether a child can be excluded from school camp if a waiver/indemnity form is not signed will depend on the circumstances and terms of the waiver and should be discussed with the school. As stated above, the state and territory guidelines for schools generally require schools to make changes to allow students at risk of anaphylaxis to participate in all activities. However, in some instances it may not be possible for the school to make the changes needed for a student with a food allergy. This will depend on factors such as how severe the food allergy is, and the type of camp, including whether it is organised or catered for by another business outside the school.

Each state and territory have specific guidelines or policies in place for the management of student allergies at school. These guidelines and policies generally acknowledge the special duty of care that a school must have to its students. Some schools may require that students sign a waiver/indemnity form before attending a school camp, particularly where that camp is run or catered for by a third party. Whether a waiver/indemnity form for a school camp is unreasonable will depend on the circumstances.

A customer may be asked to sign a waiver, or separately, an indemnity. A customer may also be asked to sign a document containing both types of agreement.

A waiver is a contractual agreement that requires one party (usually the customer) to agree that it will not make any legal claim against the other party (the business), often in the context of the customer experiencing harm or injury while using the business’ service.

An indemnity is a further agreement by a party (the customer) that it will compensate the other party (the business) for any legal liability or loss sustained by the business, as a result of harm or injury suffered by the customer.

Examples of loss for which a business might ask for compensation include the cost of any medical assistance they arrange for the customer, damages for harm to its reputation, or where there is disruption to the business due to the customer’s injury, a business may ask for compensation for the profits it would have made if not for the disruption.

Although the terms of each waiver/indemnity will differ, a term of a waiver/indemnity that tries to prevent a person from reporting a food service business to the relevant authorities would likely be invalid on the basis that it would not be in the public interest to prevent food standards regulators from being alerted to possible food safety issues.

This will depend on the terms of the waiver/indemnity, you should read the form closely to understand what types of claims the food service business has excluded.

This will depend on the facts of your situation. Venues are required to try to accommodate you, however bringing outside food into a venue may cause other issues for the business, such as food safety concerns. Businesses may, for example, want to reduce any risk that a customer could become sick from external food, which is out of their control. Pre-packaged foods, such as potato chips are less likely to carry this risk and are also less likely to be mistaken for food served by the business in contrast with more substantive foods that require reheating or refrigerating.

A cafe, restaurant or function centre can refuse to provide safe food/drink for you and refuse service. Although the restaurant should try to prepare and serve you food without your allergen(s), it will not be required to do so if this will result in unjustifiable hardship for the venue (that is, it will be extremely difficult). Factors that may be considered by the venue include:

• whether it is too difficult to provide allergen-free substitutes and prepare your food without cross contamination, and
• how severe your food allergy is (and the risk of harm to you, should you have an allergic reaction)

Where the venue considers that it is unable to provide food that is free of your allergen(s), it may be reasonable for the business to refuse service.

A customer can refuse to sign a waiver/indemnity form. It would then be up to the business whether it decides to serve the customer and accept the risk of an allergic reaction happening. Equally, the customer may decide they are not comfortable eating at that business and eat elsewhere.

Yes, businesses are entitled to request that customers sign a waiver/indemnity. From the business’ perspective, a waiver/indemnity is important to protect itself in the event that customers with severe allergies have an allergic reaction, despite the business taking reasonable precautions. Although a serious allergy that causes anaphylaxis can be considered a disability under Anti-Discrimination legislation, it is likely that requesting a waiver/indemnity be signed is a reasonable requirement and would not be discriminatory.

A customer may be asked to sign a waiver, or separately, an indemnity. A customer may also be asked to sign a document containing both types of agreement.

A waiver is a contractual agreement that requires one party (usually the customer) to agree that it will not make any legal claim against the other party (the business), often in the context of the customer experiencing harm or injury while using the business’ service.

An indemnity is a further agreement by a party (the customer) that it will compensate the other party (the business) for any legal liability or loss sustained by the business, as a result of harm or injury suffered by the customer.

Examples of loss for which a business might ask for compensation include the cost of any medical assistance they arrange for the customer, damages for harm to its reputation, or where there is disruption to the business due to the customer’s injury, a business may ask for compensation for the profits it would have made if not for the disruption.

Many people with eczema have other allergic conditions. Studies have shown that up to 30% of babies with eczema who have a family history of allergy will develop food allergy, and up to 40% develop asthma or allergic rhinitis (hay fever).

Topical steroid creams and ointments are a safe and effective treatment when they are used as directed by your doctor or nurse practitioner. Skin damage can be prevented by applying creams/ointments, including steroid creams and ointments, prescribed by your doctor as soon as itchy or rough skin is noticed. Not using enough of the eczema treatments can cause skin damage due to itching, which can lead to sores, scabs and scarring. Additionally, people who have eczema that is not well managed are more likely to have skin infections.

The following actions may reduce itch, to help control the scratch and itch cycle of eczema:

• Keep skin well moisturised. Moisturise at least twice every day.
• Use cold compresses (such as a wet face cloth) and wet dressings/wraps, as directed.
• If advised to use antihistamines, use non-sedating antihistamines. Sedating antihistamines are generally not recommended and should not be used in young children without specialist supervision.

Eczema is not caused by food, but food may trigger eczema flares. It is important to seek professional medical advice for eczema management and not restrict foods from the diet unless under medical direction. Removing foods can affect growth and nutrition.

It is best to use skincare products that do not contain any food products, fragrances or plant extracts. Just because a product claims to be ‘natural’ does not mean it is good for eczema. Talk to your doctor or nurse practitioner for the best options to suit your needs.

Eczema is a type of dermatitis (atopic dermatitis), which simply means red and inflamed skin.

It is important to go back to your doctor (dermatologist/allergy specialist/ GP/paediatrician) to discuss treatment options. There are new and very effective treatments available in Australia for severe eczema.

There are a number of things that you can do to help manage eczema:

• Reduce exposure to trigger factors (where possible). This may include an allergy assessment by an allergist or dermatologist to properly identify allergic triggers.
• Have a short, warm (not hot) bath or shower daily. Do not use soap or bubble bath. Use a soap-free wash.
• Apply topical steroid cream/ointment (as prescribed) and moisturisers straight after bathing and patting dry with a soft, clean towel.
• Use moisturiser twice a day and use enough to help maintain the skin barrier.

Did you know that doctors can prescribe more than one tube of steroid eczema cream/ointment at a time?

Depending on the amount of your body that is affected by eczema, your GP can prescribe up to 10 tubes of steroid based cream/ointment per purchase on authority script with several repeats.

In general, one script purchase should be adequate supply for one month of use. This means that if you have a large body surface area affected by eczema you might only pay the price of a regular prescription for 3, 5 or even 10 tubes of steroid cream/ointment.

Most airline terms of service say they are not responsible for any loss due to an anaphylaxis on board their aircraft. Further, some airlines require that passengers do not hold the airline responsible for any costs due to an allergic reaction. The conditions of flying with the airline are often agreed to at the time an airline ticket is purchased, regardless of whether the airline later asks that passengers sign an indemnity/waiver. If a passenger’s allergic reaction increases costs to the airline (for example, where the airline has to divert the aircraft), the passenger may have to pay these costs.

Passengers travelling with a food allergy should read the airline terms of service and conditions of travel (sometimes referred to as conditions of carriage) as these should explain whether the airline is willing to make any changes (for example wiping down the tray table) if not told in advance of passenger allergies, and whether the airline will refuse to accept responsibility for an anaphylaxis.

Each airline has its own policies and conditions which explain the changes they will make and the level of risk they will take on. It is important to review these policies before buying your ticket, as many of the rules will apply as soon as you buy your ticket. Airline policies will likely say whether a waiver/indemnity form is needed.

Whether a child can be excluded from school camp if a waiver/indemnity form is not signed will depend on the circumstances and terms of the waiver and should be discussed with the school. As stated above, the state and territory guidelines for schools generally require schools to make changes to allow students at risk of anaphylaxis to participate in all activities. However, in some instances it may not be possible for the school to make the changes needed for a student with a food allergy. This will depend on factors such as how severe the food allergy is, and the type of camp, including whether it is organised or catered for by another business outside the school.

Each state and territory have specific guidelines or policies in place for the management of student allergies at school. These guidelines and policies generally acknowledge the special duty of care that a school must have to its students. Some schools may require that students sign a waiver/indemnity form before attending a school camp, particularly where that camp is run or catered for by a third party. Whether a waiver/indemnity form for a school camp is unreasonable will depend on the circumstances.

Although the terms of each waiver/indemnity will differ, a term of a waiver/indemnity that tries to prevent a person from reporting a food service business to the relevant authorities would likely be invalid on the basis that it would not be in the public interest to prevent food standards regulators from being alerted to possible food safety issues.

This will depend on the terms of the waiver/indemnity, you should read the form closely to understand what types of claims the food service business has excluded.

This will depend on the facts of your situation. Venues are required to try to accommodate you, however bringing outside food into a venue may cause other issues for the business, such as food safety concerns. Businesses may, for example, want to reduce any risk that a customer could become sick from external food, which is out of their control. Pre-packaged foods, such as potato chips are less likely to carry this risk and are also less likely to be mistaken for food served by the business in contrast with more substantive foods that require reheating or refrigerating.

A cafe, restaurant or function centre can refuse to provide safe food/drink for you and refuse service. Although the restaurant should try to prepare and serve you food without your allergen(s), it will not be required to do so if this will result in unjustifiable hardship for the venue (that is, it will be extremely difficult). Factors that may be considered by the venue include:

• whether it is too difficult to provide allergen-free substitutes and prepare your food without cross contamination, and
• how severe your food allergy is (and the risk of harm to you, should you have an allergic reaction)

Where the venue considers that it is unable to provide food that is free of your allergen(s), it may be reasonable for the business to refuse service.

A customer can refuse to sign a waiver/indemnity form. It would then be up to the business whether it decides to serve the customer and accept the risk of an allergic reaction happening. Equally, the customer may decide they are not comfortable eating at that business and eat elsewhere.

Yes, businesses are entitled to request that customers sign a waiver/indemnity. From the business’ perspective, a waiver/indemnity is important to protect itself in the event that customers with severe allergies have an allergic reaction, despite the business taking reasonable precautions. Although a serious allergy that causes anaphylaxis can be considered a disability under Anti-Discrimination legislation, it is likely that requesting a waiver/indemnity be signed is a reasonable requirement and would not be discriminatory.

A customer may be asked to sign a waiver, or separately, an indemnity. A customer may also be asked to sign a document containing both types of agreement.

A waiver is a contractual agreement that requires one party (usually the customer) to agree that it will not make any legal claim against the other party (the business), often in the context of the customer experiencing harm or injury while using the business’ service.

An indemnity is a further agreement by a party (the customer) that it will compensate the other party (the business) for any legal liability or loss sustained by the business, as a result of harm or injury suffered by the customer.

Examples of loss for which a business might ask for compensation include the cost of any medical assistance they arrange for the customer, damages for harm to its reputation, or where there is disruption to the business due to the customer’s injury, a business may ask for compensation for the profits it would have made if not for the disruption.

Most airline terms of service say they are not responsible for any loss due to an anaphylaxis on board their aircraft. Further, some airlines require that passengers do not hold the airline responsible for any costs due to an allergic reaction. The conditions of flying with the airline are often agreed to at the time an airline ticket is purchased, regardless of whether the airline later asks that passengers sign an indemnity/waiver. If a passenger’s allergic reaction increases costs to the airline (for example, where the airline has to divert the aircraft), the passenger may have to pay these costs.

Passengers travelling with a food allergy should read the airline terms of service and conditions of travel (sometimes referred to as conditions of carriage) as these should explain whether the airline is willing to make any changes (for example wiping down the tray table) if not told in advance of passenger allergies, and whether the airline will refuse to accept responsibility for an anaphylaxis.

Each airline has its own policies and conditions which explain the changes they will make and the level of risk they will take on. It is important to review these policies before buying your ticket, as many of the rules will apply as soon as you buy your ticket. Airline policies will likely say whether a waiver/indemnity form is needed.

A customer may be asked to sign a waiver, or separately, an indemnity. A customer may also be asked to sign a document containing both types of agreement.

A waiver is a contractual agreement that requires one party (usually the customer) to agree that it will not make any legal claim against the other party (the business), often in the context of the customer experiencing harm or injury while using the business’ service.

An indemnity is a further agreement by a party (the customer) that it will compensate the other party (the business) for any legal liability or loss sustained by the business, as a result of harm or injury suffered by the customer.

Examples of loss for which a business might ask for compensation include the cost of any medical assistance they arrange for the customer, damages for harm to its reputation, or where there is disruption to the business due to the customer’s injury, a business may ask for compensation for the profits it would have made if not for the disruption.

You should travel with your ASCIA Action Plan for anaphylaxis and your ASCIA Travel Plan for people at risk of anaphylaxis.

Some airlines ask you to bring a letter or medical clearance from a doctor when flying with food allergy. Check with your airline.

For more information see Airline policy comparison for food allergy

Take your own food. See Food for a long flight with allergies.

Keep adrenaline devices near you. Store your adrenaline devices and your ASCIA Action Plan for Anaphylaxis where you can easily reach them when you have your seatbelt on, such as under the seat in front of you or in your seat pocket.

Clean surfaces to remove any possible allergen to reduce the risk of an allergic reaction.

• Research shows that particles of food allergens, including peanuts, can be found on surfaces such as seats, trays, entertainment systems (TV screens) and seatbelts.² However, studies also tell us that cleaning all surfaces that you may touch with detergent is a good way to remove food allergens.² Wet wipes and soap-based cleansers are better than water. Many airlines let passengers with food allergies board the plane before other passengers so they can clean these surfaces before the rest of the passengers are allowed on.
• Hand sanitiser, which kills germs, does not remove food allergens from hands or surfaces.

Wear long pants and long sleeves. This limits skin contact with the seats, armrests and tray tables and may reduce the risk of becoming itchy.

Wash your hands. Wash your hands before eating. If you cannot go to the bathroom to do this, use disposable wipes.

Consider where you seat children with food allergies. It may be safer to sit them between parents or carers or in a window seat, where food is less likely to spill or fall on them. Think about what is best for your situation.

Things that may make you feel more comfortable but are not proven to reduce risk

Wear a mask. There is no evidence that people are at risk of anaphylaxis from breathing in food allergens on planes. Still, a mask may make people feel more comfortable and may make strong smells less worrying while others are eating.

Don’t eat while others are eating. Some people with food allergy feel more comfortable not eating at the same time as other people who may be eating food that they are allergic to.

^2. Turner P, Dowdall N. Flying with nut and other food allergies: unravelling fact from fiction. Arch Dis Child. Published online December 28, 2024. doi:10.1136/archdischild-2024-327848

People with peanut and tree nut allergy are sometimes worried about hundreds of people opening packets of peanuts or tree nuts at the same time. While some airlines choose not to serve peanuts or tree nuts as snacks, others do. If you are worried about this, you can contact the airline to ask whether they serve these snacks before buying your air tickets.

Research shows that the risk of anaphylaxis caused by inhaling food particles is extremely low.²

Can people with food allergy react to food particles in the air of the plane cabin?

Aerosolising means changing something like a food into particles small and light enough to be carried in the air. This does not happen easily with most food proteins.

A review that looked at all the recent studies of allergic reactions during flights found that reactions to airborne food particles are very rare.²

Aerosolisation of nut allergens from other passengers removing the shell of peanuts or other nuts and eating them has not been shown to cause anaphylaxis, even in small, closed-in spaces, like on a plane.²

However, allergen particles can stick to surfaces such as tray tables, screens and seat belts, for example.² If someone touches a surface that has an allergen on it, they could experience an allergic reaction. Most reactions caused by touching an allergen cause mild to moderate skin reactions that can be treated with antihistamines. Touch reactions rarely lead to anaphylaxis unless a contaminated hand is put in the mouth.

A study found that when 84 children with peanut allergy were put in a room and sat half a meter away from a bowl of peanuts for 30 minutes, there were no moderate to severe allergic reactions, and only two children (2%) had mild symptoms during the hour of observation sitting in the room near the bowl of peanuts.³

Studies show that peanut allergens that can be transferred through touch are more of a risk than the breathing in of nut particles in the air when other passengers eat nuts during a flight.²

Some people with food allergy do not like the smell of the food they are allergic to. This is the case for many people with peanut allergy, for example. Smelling peanut butter or satay can make them feel uncomfortable. However, the particles responsible for the smell are not the proteins that trigger allergic reactions. Wearing a face mask may reduce the smell of the allergen.

Can food allergens be spread through aircraft cabin ventilation systems?

Companies that make air filter systems, including those for planes, use HEPA filters that remove 99.97% of particles, including allergens. Air circulation in the cabin moves across the plane rather than along it and is also filtered many times. This helps prevent the spread of airborne particles.²

^2. Turner P, Dowdall N. Flying with nut and other food allergies: unravelling fact from fiction. Arch Dis Child. Published online December 28, 2024. doi:10.1136/archdischild-2024-327848

^3. Lovén Björkman S, Sederholm U, Ballardini N, et al. Peanuts in the air – clinical and experimental studies. Clin Exp Allergy. 2021;51(4):585-593. doi:10.1111/cea.13848

It’s not just peanuts and tree nuts that can trigger anaphylaxis. An allergy to any food for example milk, egg or wheat is just as serious as an allergy to peanut and tree nuts.

• Passengers can bring their own food on to a plane and this could include peanuts and tree nuts. The airline has no control over this.
• In some countries, peanuts and tree nuts are used in many foods. People from these countries who fly may want to eat foods they are used to when they travel.
• Food allergy is much less common in some countries and so some airlines do not think it is a priority
• In some countries, peanut and tree nut allergies are uncommon

Taking your own food is the safest option. Reasons for this include:

• Airline staff serving the meal are not aware of the manufacturing processes. They may not be able to provide passengers with all the correct information when asked questions about the food content.
• Many meals on flights now have allergens listed; however, common allergens and labelling laws vary between countries.
• Eating a meal on a plane is like eating out in a restaurant, mistakes can be made, and the meal may accidentally contain the allergen. However, there is a greater risk if something goes wrong during air travel, as there is no access to emergency care.
• Even if an airline does provide allergen free meals, there is a risk that a passenger with food allergies could either get the wrong meal or not get a meal at all if it is accidentally given to someone else.

Special meals for people with other dietary, religious and cultural needs (not food allergy) very rarely cause a life-threatening emergency if the wrong meal is served. It is not likely that a person’s physical health is greatly harmed from being served the wrong special meal. As a result, airlines are more likely to offer these special meals.

Some airlines do offer a nut fee meal. Even if a nut free meal is offered, we recommend you don’t eat it because:

• There is a risk that the passenger with food allergy will not get the right meal. Meals sometimes go missing or are given to another passenger by mistake. The passenger with food allergy could either get the wrong meal or not get a meal at all.
• There is no guarantee that the nut free meal will not accidentally contain nuts.

People can be allergic to any food, so nut free meals are not safe for people allergic to foods other than nuts.

Ingredient lists on packaged food help people make informed choices about whether to eat it. However, food labelling laws vary between countries, resulting in different rules on what must be included on a food label. If food is imported into Australia, it must be labelled according to Australian food law.

Language and translation challenges can also complicate matters when on an airline or in another country.  If a food is made in another country and served while outside of Australia or its airspace, Australian food labelling rules do not apply. 

Also, Precautionary Allergen Labelling (PAL) statements, such as “May contain” on packaged food are not regulated in Australia or in most other countries, so they are not enforceable under the law. In Australia, food manufacturers do not have to include a PAL statement on their packaged food, even if there is a risk of cross-contamination. While some manufacturers use formal risk assessments to help them decide whether to include a PAL statement, others do not. A&AA strongly advises people with food allergies not to eat any food with a PAL statement during air travel, even if they typically eat foods these foods, as it is hard to get medical help while in a plane.

Although the airline is responsible for serving food, like any food service, staff cannot guarantee its safety because they do not make every component of the meal. Meals are provided to airlines by contracted third-party catering suppliers. Allergen management depends on these food manufacturers and their processes, which the airline does not control.

For example, on an international flight, one meal may be provided by an Australian catering company, while the meal served after a stopover in Singapore might come from a Singaporean catering company, where food is prepared according to Singaporean food labelling laws, which are different from those in Australia.

Pharmacists can substitute one adrenaline injector for another if the “brand substitution is not permitted” box is not ticked or your prescription is for an Anapen® junior or Anapen® 300 (these devices are no longer available in Australia).

The pharmacist should:

• ask for your permission to do this
• show you how to use the adrenaline injector – instructions for using Anapen® and EpiPen® are different

It is important that you have an ASCIA Action Plan for Anaphylaxis that matches your adrenaline injector. 

If you do not have an Action Plan for Anaphylaxis that matches your adrenaline injector then you will need to go back to your doctor and get the matching Action Plan. 

If someone is experiencing anaphylaxis, an adrenaline injector should be given.

If the prescribed dosage or brand of adrenaline injector is not available, any available adrenaline injector should still be given. This includes any brand (Anapen® or EpiPen®) using the following dosing guide.

The ASCIA Action Plan for Anaphylaxis states that further adrenaline may be given if there has been no response after 5 minutes: 

• If 300 micrograms of adrenaline has been given as a first dose and the child (over 20 kg) or adult requires a second dose of adrenaline, the adrenaline device that is available should be given.
• If 150 micrograms of adrenaline has been given as a first dose and the child (under 20 kg) requires a second dose of adrenaline (if symptoms of anaphylaxis persist or recur), a 300 microgram dose of adrenaline may be given if a 150 microgram adrenaline injector is not available.

The information above is from ASCIA’s Frequently Asked Questions on Adrenaline Injectors

Both adrenaline injector brands have windows on the devices to check to see what the medication inside the device looks like.  

It is better that you check the colour of the fluid when it is not an emergency, for example check the fluid when you check the device expiry. A&AA recommend you routinely check your device to make sure it is still okay and has not expired.

It is better to know that the device you are carrying is in good condition than find something is not right when you need to use it for anaphylaxis.  

Discoloured or expired adrenaline injectors don’t work as well and should not be relied on to treat anaphylaxis BUT if a discoloured or expired adrenaline injector is the only one available it is better to use this rather than no adrenaline injector.

Used and unused (and expired) adrenaline injectors must always be handled with care and should never be thrown in the regular or recycling bin.

They contain a needle that can be dangerous if not handled correctly and should always be placed in a sharps disposal container. Speak with your pharmacist or doctor about disposal of your adrenaline injector. 

Used adrenaline injectors can be given to ambulance paramedics who treat your anaphylaxis.

Unused (and expired) adrenaline injectors can be taken to pharmacies who can dispose of them using the Return Unwanted Medicine (RUM) campaign.

It is very rare that something goes wrong with an adrenaline injector.

If you find that your adrenaline injector has not worked properly, we recommend you report this once the emergency has been managed.

• Keep the device and take note of the serial number and expiry date
• Contact Allergy & Anaphylaxis Australia on 1300 728 000 for support
• You may wish report the problem yourself. You can do this through the Therapeutic Goods Administration (TGA) at Report a problem or side effect | TGA
• Contact the manufacturer at:
  • Anapen® –  Arrotex 1800 195 055
  • EpiPen® – Viatris 1800 931 625